Short-term effectiveness of arthroscopic repair via modified subacromial viewing portal in treatment of Lafosse Ⅰ subscapularis tendon tears / 中国修复重建外科杂志

OBJECTIVE@#To investigate short-term effectiveness of arthroscopic repair via modified subacromial viewing portal (hereinafter referred to as modified viewing portal) in treatment of LafosseⅠsubscapularis tendon tears.@*METHODS@#A clinical data of 52 patients with LafosseⅠsubscapularis tendon tears, who underwent the arthroscopic repair via modified viewing portal between October 2020 and November 2022 and met the selective criteria, was retrospectively analyzed. There were 15 males and 37 females with an average age of 63.4 years (range, 41-76 years). Twelve patients had trauma history and the other 40 patients had no obvious inducement. The main clinical symptom was shoulder pain and the hug resistance tests were positive in all patients. The interval between symptom onset and admission ranged from 3 to 26 months (mean, 7.2 months). The shoulder pain and function were evaluated by visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and University of California Los Angeles (UCLA) score before operation and at 12 months after operation. The shoulder range of motion (ROM) of forward flexion, abduction, and external rotation and the internal rotation strength were measured before operation and at 3 and 12 months after operation. MRI was performed at 3-6 months after operation to assess the tendon healing and the structural integrity and tension of reattached tendon. Patient's satisfactions were calculated at last follow-up.@*RESULTS@#All incisions healed by first intention, no complication such as incision infection or nerve injury occurred. All patients were followed up 12-37 months (mean, 18.5 months). The VAS, UCLA, and ASES scores at 12 months after operation significantly improved when compared with those before operation ( P<0.05). The ROMs of abduction and forward flexion and the internal rotation strength at 3 and 12 months significantly improved when compared with those before operation ( P<0.05); and the ROMs at 12 months significantly improved compared to that at 3 months ( P<0.05). However, there was no significant difference ( P>0.05) in the ROM of external rotation at 3 months compared to that before operation; but the ROM at 12 months significantly improved compared to that before operation and at 3 months after operation ( P<0.05). Thirty-one patients underwent MRI at 3-6 months, of which 28 patients possessed intact structural integrity, good tendon tension and tendon healing; 3 patients underwent tendon re-tear. At last follow-up, 41 patients (78.8%) were very satisfied with the effectiveness, 7 were satisfied (13.5%), and 4 were dissatisfied (7.7%).@*CONCLUSION@#Arthroscopic repair via modified viewing portal for Lafosse Ⅰsubscapularis tendon tears, which can achieve the satisfactory visualization and working space, can obtain good short-term effectiveness with low overall re-tear risk.

Arthroscopic repair and loosening of shoulder arthroscopy for patients with old supraspinatus tendon tears and dysfunction / 临床外科杂志

Objective To explore the effect of arthroscopic release combined with suture bridge treatment of old supraspinatus tendon tear with shoulder dysfunction.Methods 40 patients with old supraspinatus tendon tear were analyzed retrospectively.According to the operation method, the patients were divided into control group and experimental group with 20 cases each.Treatment of single row of loose strip anchor nails under arthroscope in control group, the experimental group was treated with the technique of loosening suture bridge under arthroscope.VAS score and ASES score were assessed before operation and after 1 month, 3 months, 6 months, and 12 months.Range of motion (ROM) was evaluated before operation and after 12 months.The analysis of complication was also preceded.Results All patients completed 12 months of follow-up.There were no difference between experimental group and control group in ASES score (27.6±5.5 vs 27.5±3.6), VAS score (7.6±0.5 vs 7.5±0.7) and shoulder bends forward[ (83.6±12.4) °vs (80.6±14.5) °], abduction[ (75.6±8.4) °vs (72.8±9.3) °], intorsion[ (20.1±3.7) °vs (21.2±2.9) °] at pre-operation (P＞0.05).At 1 month, 3 months, 6 months, and 12 months post-operation, VAS scores were 5.8±0.6, 4.2±0.5, 3.0±0.2 and 1.8±0.4 in experiment group and were 6.1±0.3, 4.4±0.6, 3.5±0.4 and 2.2±0.3 in control group, the difference was significant (P＜0.05).ASES scores were 35.8±3.6, 54.2±4.7, 73.1±3.2 and 85.8±2.6 in experiment group and were 34.1±3.3, 49.4±3.6, 69.5±2.4 and 72.2±3.1 in control group, the difference was significant (P＜0.05).After 12 months, there was a significant improvement in joint flexion, abduction, and lateral internal rotation in experimental group[ (160.4±10.2) °, (158.7±9.7) °, (48.1±5.9) °] than the control group[ (138. 4 ± 7. 2) °, (128. 7 ± 6. 5) °, (30.1 ± 4. 2) °]. No complications occurred in two groups, such as anchor loosening, pain, swelling and other complications. Conclusion Arthroscopic release combined with Suture Bridge can effectively improve the function of shoulder in patients with old supraspinatus tendon tear.

Rotura del tendón del pectoral mayor: técnica de reparación abierta durante periodo agudo / Pectoralis major tendon rupture: open repair technique during acute period

La rotura del tendón del pectoral mayor es considerada una lesión infrecuente en lo descrito en la literatura, pero esa lesión ha tenido un aumento exponencial en sus reportes a partir de los años 90. A continuación, presentamos la resolución quirúrgica de una rotura completa del tendón del pectoral mayor mediante una técnica simple y reproducible en un hombre de 34 años, sometido a una alta demanda física diaria. Tenemos ya publicado diferentes técnicas de reparación en periodo agudo como reconstrucción en lesiones crónicas. Nosotros presentamos una técnica de reparación para rotura aguda que consiste en la reinserción mediante anclas de titanio en su huella insercional mediante una configuración de suturas que forma un constructo estable y resistente, que permita al paciente rehabilitarse en forma precoz y satisfactoria para intentar volver al mismo nivel de actividad pre lesional. Con eso, aportamos al especialista una manera sencilla de enfrentarse y planificar la reparación de ese tipo de lesiones infrecuentes que no siempre estamos acostumbrados a resolver.

Pectoralis major tendon rupture is an infrequent injury in what has been described in the literature so far. Lately, an exponential increase in reported cases of this injury has been observed. We present a simple and reproducible surgical technique in a 34 years old male subject to a high daily physical demand. Different techniques have been published for tendon repair during the acute period as well as reconstruction in chronic lesions. We present a technique for acute rupture that consists of the reinsertion by means of titanium anchors in its insertional footprint through a suture configuration that forms a stable and resistant construct, that allows the patient to be rehabilitated in an early and satisfactory manner with the objective to return to the same Level of pre-injury activity. With this we provide the specialist with a simple way to manage the repair of these infrequent injuries.

Ultrasonographic Finding of Painful Hemiplegic Shoulder Associated with Motor Recovery after Stroke

OBJECTIVE: To analyze the relationship between painful hemiplegic shoulder (PHS) and ultrasonographic (US) findings according to the motor recovery stage of the stroke. METHOD: The medical records were reviewed retrospectively in 82 stroke patients from January 2005 to November 2009 who undertook US examination on hemiplegic shoulder. The clinical data collected were age, gender, stroke type, affected side, duration from stroke onset, manual function test (MFT) and the Brunnstrom stage of arm. The presence of spasticity, glenohumeral subluxation and sensory impairment were also investigated. The patients were classified into three groups according to the Brunnstrom recovery stage: the first, second and third recovery stages (RS1, RS2 and RS3). Furthermore, the correlations between US findings and the clinical characteristics according to the Brunnstrom recovery stage were analyzed. RESULTS: The presence of spasticity, glenohumeral subluxation, sensory impairment (proprioception) and MFT scores had statistically significant differences in each group. Among the 82 stroke patients, 62 patients (75.6%) had abnormal findings in US examination. The common abnormal structures were supraspinatus tendon (SST), biceps long head tendon (BLH), subacromial-subdeltoid bursa (SA-SD bursa). The frequencies of total US abnormality in each group were not significantly different (p=0.07). However, the SST abnormality was more frequent in the RS1, and the BLH and SA-SD bursa abnormality were more frequent in the RS3 (p<0.05). CONCLUSION: In this study, abnormal findings in US examination are frequent in PHS. The abnormal SST is related to the flaccidity, and the abnormal BLH and SA-SD bursa are related to the overuse.

Arthroscopic Repair of Combined Rotator Cuff Tears Involving the Subscapularis Tendon / 대한정형외과학회잡지

PURPOSE: Subscapularis tendon tears associated with supraspinatus tendon tears are often found during rotator cuff repair. However, there have been only a few reports about both subscapularis and rotator cuff repair. The authors conducted arthroscopic repair for cuff tear associated with subscapularis tendon tear and assessed its outcomes. MATERIALS AND METHODS: We evaluated 320 cases of arthroscopic repair following rotator cuff tear between June 2006 and January 2009 at Gil Medical Center. Out of 66 cases (21%) associated with subscapularis tear, forty cases of bone to tendon repair using suture anchor were selected except for 26 cases of tendon to tendon repair. Clinical outcomes of 25 cases followed up for over a year were finally assessed. Clinical outcomes were evaluated using the following measures: range of shoulder motion, muscle strength, belly press test, Visual Analogue Scale (VAS) on pain, and University of California Los Angeles (UCLA) score. RESULTS: The average VAS pain scale improved from 5.3 preoperatively to 1.4 postoperatively. Internal rotation strength increased from its preoperative level, 4.1 to 4.2 in postoperative 6 months and to 4.6 at last follow-up. Range of internal rotation increased from the second lumbar level at postoperative 6 months to the 11th thoracic level at last follow-up. UCLA score had significantly improved from 17.4 to 30.8 (p<0.05). CONCLUSION: It is recommended that concurrent repair of the subscapularis tendon during rotator cuff repair for a satisfactory treatment result.